The trend of an inability to spend the budget in the health sector persists, with only 41.86% spent in 10 months of the current fiscal 2021-22. And that despite the government's prioritising of the health sector due to the Covid-19 pandemic and allocating Tk32,732 crore for it.
With barely a month to go, 59% of the allocation is yet to be spent. Experts think much of the remaining health sector funds will eventually be returned as it has every year.
Most of the sectors, including power and the Election Commission, have spent nearly 70% of their budget allocations.
Under the Annual Development Plan (ADP), two divisions under the Ministry of Health, the Health Service Division and the Medical Education Family Welfare Division, were allocated Tk9,989 crore and Tk2,080 crore respectively in the current fiscal year. From July to April, the Health Service Division spent Tk3,970 crore or 39.75% and the Medical Education Family Welfare Division was able to spend Tk1,082 crore or 52.03% of the total allocation.
By 30 June, the divisions can at best spend in the amount of Tk3,000-4,000 crore. The rest of the money will be refunded. In fiscal year 2020-21, a total of Tk5,369 crore was returned to the government exchequer.
Experts blamed the situation on a lack of planning and urged the government to increase the capacity of the health ministry. In their opinion, the health ministry does not have the capacity to spend money like other ministries.
They observed that every year the operating budget is spent while some 25% of the development budget remains unused. A large part of the development budget is spent on procurement. Development budget money is unused for various reasons, including an absence of procurement related skills, bureaucratic complexities and late release of funds.
Prof Dr Rashid-E-Mahbub, president of the Health Rights Movement, told The Business Standard that those in charge of budgeting lack efficiency. The people involved in the budgeting of the Ministry of Health are mainly doctors, who do not have skills in accounting and finance. Budgeting means not just allocating money, but spending it efficiently. Those involved in budgeting need to be imparted training.
Professor Dr Muzaherul Haque, a former adviser to the World Health Organization, told The Business Standard that so far, the Ministry of Health has not been able to fully spend the money allocated in the budget in any year.
"Officials of the health ministry do not have the skills of making budget projections, budget approval and spending funds. Before presenting the budget, you have to chart strategic plans and fix priorities. In line with the budget formulation, the work has to be completed within the stipulated time and regular monitoring is a must," he noted.
Allocation, spending capacity need to be increased
The current per capita health expenditure in Bangladesh is $45 while in Nepal it is $58, in India it is $73, in Bhutan it is $103 and in Sri Lanka it is $157. Experts believe that it is necessary to increase the allocation in the budget by 8-10% and to come out of the tradition of allocating 5-6% of the total budget in the health sector.
Dr Ahmed Mushtaque Raza Chowdhury, convener, told TBS, "We have to know what we really want. Otherwise, the problem of not being able to spend the budget money will not be solved.
"To achieve universal health care, you need to decide where to invest and spend accordingly. The budget allocation for the development of health research, primary health care and upazila hospitals should be increased," he added.
Some 68% of the total health expenditure is out of pocket expenditure. In other words, it comes from the pockets of citizens, while 23% comes from the government.
Dr Ahmed Mushtaque Raza Chowdhury thinks it is possible to reduce the pressure of health expenditure on citizens by increasing the allocation of medicines in the budget and the expenditure on primary health care.
Dr Enamul Hoque, Additional Secretary (Budget-1 & 2 Branch), Ministry of Health, told The Business Standard, that it seems that spending will be higher in the upcoming fiscal year than in previous years.
"Last year, many equipment shipments were suspended due to lockdown – a problem we do not have this year. Everyone has been instructed to purchase as per requirements under the purchase rules," added Dr Enamul Hoque.